Diagnosing and preventing heart problems

What it means 

When fats or other substances build up in the blood, blood vessels can become blocked (atherosclerosis). This can reduce the amount of blood flowing through the heart. It may cause:

• angina – pain or tightness in the chest when not enough blood is flowing to the heart. This needs to be checked because it may also be a symptom of a heart attack
• heart attack – pain in the chest due to permanent damage to the heart. This needs emergency treatment.

Risk may increase with some types of:

• chemotherapy
• immunotherapy
• radiation therapy to the chest for certain cancers

What it means 

Blood clots are clumps of blood that can block blood vessels. They may cause serious conditions including:

• stroke – when the blocked blood vessel restricts blood flow to the brain (called an ischaemic stroke). Strokes can also be caused by bleeding in the brain if an artery leaks or splits (called a haemorrhagic stroke)
• pulmonary embolism (PE) – when a blood clot blocks the supply of blood to the lungs; this can be life-threatening
• deep vein thrombosis (DVT) – when a blood clot forms in a deep vein, often in the leg; can lead to pulmonary embolism.

Risk may increase with some types of:

• cancer
• chemotherapy
• hormone therapy
• immunotherapy
• ports, etc.
• radiation therapy to the chest for certain cancers (may increase stroke risk, not PE or DVT)
• surgery
• targeted therapy

What it means 

Damage or weakening of the heart muscle (cardiomyopathy) may mean the heart becomes too weak to pump blood around the body properly. This can cause shortness of breath and fatigue. Cardiomyopathy must be treated quickly to prevent it becoming permanent.

Risk may increase with some types of:

• chemotherapy
• immunotherapy
• radiation therapy to the chest for certain cancers
• targeted therapy

What it means 

When the heart muscle (myocardium) becomes inflamed (swollen or irritated) it can affect the heart’s ability to pump blood. This may cause chest pain, shortness of breath and rapid or irregular heartbeats, and can be life-threatening if not treated early.

Risk may increase with some types of:

• immunotherapy
• radiation therapy to the chest for certain cancers

What it means 

The heart has an electrical system that tells it to beat. If this system is not working properly, it can lead to a heartbeat that is irregular (beating too fast or too slow). This is called arrhythmia. For example, atrial fibrillation (AF) is an irregular heartbeat that is often faster than usual. Arrhythmia can cause you to be light-headed or dizzy and, in some cases, to faint. It may also be a sign of heart attack, heart failure or heart inflammation (myocarditis, see above).

Risk may increase with some types of:

• chemotherapy
• immunotherapy
• radiation therapy to the chest for certain cancers
• targeted therapy

What it means

Cancer treatments may also affect the heart by causing:

• high blood pressure (hypertension) – when the force of the blood pushing against the artery walls is too high for a long time or the arteries become stiff, the heart has to work harder to pump blood. This increases the risk of heart attack and stroke
• high cholesterol (hyperlipidaemia) – a build-up of fats (lipids) in the blood. This increases the risk of heart attack, stroke and kidney damage
• high blood sugars (hyperglycaemia) – when there is too much glucose (sugar) in your blood. This increases the risk of heart attack, angina and stroke.

See your GP for regular check-ups for these issues.

Risk may increase with some types of:

• chemotherapy
• hormone therapy (e.g. androgen deprivation therapy)
• immunotherapy
• targeted therapy

What does it check for? 

If your heart has existing damage or is under strain, the cells may release particular proteins (called biomarkers) into the blood. 

How it is done

A sample of your blood will be collected with a needle from a vein in your arm. It will be sent to a laboratory where a pathologist will check your blood for certain biomarkers.

What does it check for? 

This shows how fast or slow your heart is beating and checks for irregular heartbeats (called arrhythmias). It can also show if you have had a heart attack.

How it is done

Several leads (electrodes) will be stuck to your chest; any hair on your chest may need to be shaved so the electrodes stick properly. The electrodes are connected to a computer that records your heart beating.

What does it check for? 

This looks at how well your heart muscle and heart valves are working. 

How it is done

This is a type of ultrasound scan. The person doing the ultrasound (sonographer) will spread gel on your chest and then move a small device (transducer) over the chest. The transducer sends soundwaves to a computer to create pictures of your heart. 

What does it check for? 

This scan may be done if an echo scan suggests a more serious cardiovascular problem. A CMRI shows how well the heart is pumping and if the valves are working properly. Most people will not need this test.

How it is done

This scan uses a powerful magnet and radio waves to create detailed cross-sectional pictures of your heart. During the scan, you may be injected with a dye (called contrast) to help make the pictures clearer. You will lie on a table inside a large metal tube that is open at both ends. The scan is noisy but painless.

What does it check for? 

This scan checks for any blockages or damage in your heart and surrounding blood vessels. It may be called a CTCA.

How it is done

A small tube (cannula) will be put into a vein in your arm. You will lie on a table that slides into the CT machine. Dye (called contrast) will be injected into the cannula to help show if there is any narrowing or blockage in your heart arteries. You will be asked to hold your breath for about 10 seconds and stay still while the images are taken.

What does it check for?

This test is used to check if the arteries around your heart (coronary arteries) have narrowed or are blocked. Most people will not need this test.

How it is done

A thin, flexible tube (catheter) is inserted into the largest artery in your body (the aorta) through your wrist or the groin. It is then threaded up into the coronary arteries. A dye (called contrast) is injected into the catheter, and x-rays are taken to show up any blockages.

What does it check for? 

This measures how well your heart and lungs are working during exercise.

How it is done

Your heart rhythm and lung function will be monitored while you walk on a treadmill or ride a stationary bike. The appointment may take about 90 minutes, but you will only be exercising for 5–15 minutes. An echo scan might be done before and after the stress test. You will be given instructions on what you can eat or drink the day before the test.